Provider Demographics
NPI:1811353766
Name:CHOI, JAE HYUK
Entity type:Individual
Prefix:
First Name:JAE
Middle Name:HYUK
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 4370 S
Mailing Address - Street 2:STE 7
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2624
Mailing Address - Country:US
Mailing Address - Phone:801-281-1001
Mailing Address - Fax:
Practice Address - Street 1:153 E 4370 S
Practice Address - Street 2:STE 7
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2624
Practice Address - Country:US
Practice Address - Phone:801-281-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician